Acne,eczema and pemphigus.pptx

Acne, eczema and pemphigus.pptx

1. REGENCY INSTITUTE OF NURSING,KANPUR TOPIC- Acne, Eczema and Pemphigus By- Shreya Yadav Nursing tutor Medical surgical Nursing

2. ACNE Acne is a common follicular disorder affecting susceptible hair follicles, most commonly found on the face, neck, and upper trunk. INCIDENCE RATE Acne is the most commonly encountered skin condition in adolescents and young adults between ages 12 and 35. Both genders are affected equally, although onset is slightly earlier for girls.

3. ETIOLOGY Stress Hormonal Changes: Hormonal changes during puberty, menstruation, pregnancy and menopause too may trigger breakouts. Medications: corticosteroids, testosterone or lithium Diet: High sugar Excess oil (sebum) production Hair follicles clogged by oil and dead skin cells Bacteria Inflammation Cosmetics

4. PATHOPHYSIOLOGY

5. CLINICAL MANIFESTATION Whiteheads (closed plugged pores) Blackheads (open plugged pores) Small red, tender bumps (papules) Pimples (pustules), which are papules with pus at their tips Large, solid, painful lumps under the skin (nodules) Painful, pus-filled lumps under the skin (cystic lesions)  Inflammatory pustules, and inflammatory cysts

6. DIAGNOSTIC EVALUATION: History collection Physical examination Biopsy of lesion Blood test MANAGEMENT : Medical management: Benzoyl Peroxide- reduction of inflammatory lesions and depress sebum production. Benzoyl erythromycin, and benzoyl sulfur combinations are available over the counter and by prescription. Vitamin A acid (Tretinoin) applied topically is used to clear the keratin plugs.

7. Oral antibiotics, such as tetracycline, doxycycline , and minocycline . Hormonal therapy(Estrogen and progestrone ). SURGICAL MANAGEMENT: Drainage Of Pustules And Cysts Excision Of Sinus Tracts And Cysts Cryotherapy Dermabrasion For Scars Laser Resurfacing Of Scars

8.   NURSING MANAGEMENT: Patients are instructed to avoid manipulation of pimples or blackheads. Should be warned that discontinuing these medications can exacerbate acne, lead to more flare-ups(sudden out burst), and increase the chance of deep scarring. Manipulation of the comedones, papules, and pustules increases the potential for scarring.  Caution the patient to avoid scrubbing the face. Taking prescribed medications, patients are instructed to wash the face and other affected areas with mild soap and water twice each day to remove surface oils and prevent obstruction of the oil glands.

9. ECZEMA DEFINITION: Eczema comes from the Greek for ‘boiling’ – a reference to the tiny vesicles (bubbles) that are often seen in the early acute stages of the disorder • ‘Dermatitis’ means inflammation of the skin and is therefore, strictly speaking, a broader term than eczema.

10. Risk factor Genetic   Exposure to smoke, air pollutants, harsh soaps, fabrics such as wool, and some skin care products.  High levels of stress, anxiety or depression. Infection Touching something you’re allergic to . Dry weather Certain food(peanuts, dairy, eggs) Drugs(corticosteroids, penicillin)

11. CLINICAL MANIFESTATION: Dry skin Itchy skin Skin rash Bumps on your skin. Thick, leathery patches of skin. scaly or crusty skin. Swelling

12. DIAGNOSTIC EVALUATION History taking :- A physician ask the question focusing on when the rash appears , where it appears & How often it does it does so . They also ask about itching , any food or inhaled allergen , temp . changes etc. Blood test such as eosinophilia count & IgE because eosinophilia count & serum IgE levels are raised. Skin biopsy :- A doctor first numbs the skin and then removes one or more small pieces of skin . A pathologist then examines the skin sample under a microscope.

13. MANAGEMENT MEDICAL MANAGEMENT: Corticosteroids such as Hydrocortisone, Betamethasone (Betnovate ), Prednisolone . Topical immunomodulators like pimecrolimus & tacrolimus were developed after corticosteroid treatments. Antibiotic such as Ceftriaxone should be given. Immunosuppressant such as methotrexate should be given. Antihistamine.

14. NURSING MANAGEMENT:  A voiding contact with known irritants like soaps, perfumes detergents, jewelry, environmental irritants etc .  Bathing in warm,not hot water and using a mild soap.  wearing loose-fitting clothing (cotton clothing may be less irritating for many people than wool or synthetic fibers). The use of cool compresses to help control itching. Wearing protective gloves for activities that require frequent submersion of the hands in water. Avoiding activities that make you hot and sweaty as well as abrupt changes in temperature and humidity .

15.  Pemphigus Pemphigus is   a blistering autoimmune disease that affects the skin and mucous membranes

16. RISK FACTOR Genetic . Gender(Both male and female). Age (middle age, rarely affect childhood) Associated with autoimmune disorder such as rheumatoid arthritis, myasthenia gravis. Drugs (Penicillin and captopril ).

17. TYPES OF PEMPHIGUS There are mainly three types of Pemphigus: Pemphigus vulgaris- The  most common form of the disorder is pemphigus vulgaris. It occurs when antibodies attack Desmoglein (a protein that is present in the epidermal layer of skin). Blisters usually first appear in the mouth. The blisters don’t itch. They can be painful. Blisters may then appear on the skin and sometimes on the genitals

18. Pemphigus foliaceus – The least severe of the three types is Pemphigus foliaceus(PF ). Desmoglein-1, is the protein that is destroyed by the autoantibody. It doesn’t cause blisters in the mouth. The blisters first appear on the face and scalp. Blisters then appear on the chest and back. The blisters are usually itchy and painless.

19. 3. Paraneoplastic pemphigus The least common and most severe type of pemphigus is paraneoplastic pemphigus (PNP ). This disorder is a complication of cancer. The blisters and sores may appear in the mouth, on the lips, and on the skin. This type may also cause scars on the eyelids and eyes. It can also cause lung problems

20. PATHOPHYSIOLOGY: Due to etiological factor Antigen and antibody reaction immune system mistakenly attacks cells in the top layer of the skin (epidermis) and the mucous membranes. produce antibodies against desmogleins(proteins that bind skin cells to one another) Sign and symptoms occur( skin bullae enlarge, rupture, and leave large, painful eroded areas that are accompanied by crusting and oozing)

21. Clinical Manifestations Oral lesion appearing as irregularly shaped erosions that are painful, bleed easily, and heal slowly. The skin bullae enlarge, rupture, and leave large, painful eroded areas that are accompanied by crusting and oozing. A characteristic offensive odour emanates from the bullae and the exuding serum. NIKOLSKY’S SIGN: The Nikolsky sign is dislodgement of intact superficial epidermis by a shearing force.

22. DIAGNOSTIC EVALUATION   History collection Physical examination Direct   Immunofluorescence : A biopsy sample will be examined by a technique known as direct immunofluorescence . Blood test

23. MANAGEMENT Corticosteroids , usually prednisolone(To control blisters).  Immunosuppressive drugs: azathioprine, cyclophosphamide. Antibiotic (Tetracycline).

24. NURSING MANAGEMNET O ral hygiene is important to keep the oral mucosa clean and allow the epithelium to regenerate. Frequent rinsing of the mouth is prescribed to rid the mouth of debris and to soothe ulcerated areas. The lips are kept moist with lip balm. Advice patient to do not scratch the wound. NURSING DIAGNOSIS: Acute pain of skin and oral cavity related to blistering and erosions Impaired skin integrity related to ruptured bullae Anxiety and ineffective coping related to the appearance of the skin and no hope of a cure Deficient knowledge about medications and side effect